Impact of sociodemographic and health variables on mini-mental state examination in a community-based sample of older people

The mini-mental state examination (MMSE) has been widely used as a screening instrument for cognitive disorders. Age, schooling and many other sociodemographic and health variables may be associated with a worse performance on the MMSE. The objectives of this study were to investigate the distribution of MMSE percentiles in a large Brazilian community-based elderly sample, divided according to age and schooling, and to evaluate the impact of sociodemographic and health variables on groups of elderly people with lower cognitive performance. The MMSE was applied to a sample of 2,708 adults, aged 60 years and older. Of this population, 1,563 individuals were living in the city of São Paulo, while 1,145 were living in the city of Ribeirão Preto. The subjects were divided into six groups according to the amount of schooling that they had received (no formal education, 1–4 and ≥5 years) and age (<75 and ≥75 years old). To each one of the subgroups a stepwise logistic regression was applied, considering the following dependent variable: subjects who scored under or above the 15th percentile on MMSE. High scores on a depression scale, high scores on a memory complaints scale and low socio-economic levels were associated with poorer performance on the MMSE. Being currently employed and being married were related to higher scores on the test. Many sociodemographic and health variables can influence MMSE performance, with impacts depending on age and schooling. Clinicians and primary care physicians should pay attention to variables that may be associated with worse cognitive performance.     

Vitamin D deficiency is associated with low mood and worse cognitive performance in older adults.

BACKGROUND: Vitamin D deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders. This study examined the relationship among vitamin D status, cognitive performance, mood, and physical performance in older adults. METHODS: A cross-sectional group of 80 participants, 40 with mild Alzheimer disease (AD) and 40 nondemented persons, were selected from a longitudinal study of memory and aging. Cognitive function was assessed using the Short Blessed Test (SBT), Mini-Mental State Exam (MMSE), Clinical Dementia Rating (CDR; a higher Sum of Boxes score indicates greater dementia severity), and a factor score from a neuropsychometric battery; mood was assessed using clinician's diagnosis and the depression symptoms inventory. The Physical Performance Test (PPT) was used to measure functional status. Serum 25-hydroxyvitamin D levels were measured for all participants. RESULTS: The mean vitamin D level in the total sample was 18.58 ng/mL (standard deviation: 7.59); 58% of the participants had abnormally low vitamin D levels defined as less than 20 ng/mL. After adjusting for age, race, gender, and season of vitamin D determination, vitamin D deficiency was associated with presence of an active mood disorder (odds ratio: 11.69, 95% confidence interval: 2.04-66.86; Wald chi(2) = 7.66, df = 2, p = 0.022). Using the same covariates in a linear regression model, vitamin D deficiency was associated with worse performance on the SBT (F = 5.22, df = [2, 77], p = 0.044) and higher CDR Sum of Box scores (F = 3.20, df = [2, 77], p = 0.047) in the vitamin D-deficient group. There was no difference in performance on the MMSE, PPT, or factor scores between the vitamin D groups. CONCLUSIONS: In a cross-section of older adults, vitamin D deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.     

The mini-mental state examination: age and education distribution for a Latin American population

The Mini Mental State Examination (MMSE) is used widely internationally. Data on population age and gender distribution of MMSE scores outside of the US is rare. The Composite International Diagnostic Interview (CIDI), which incorporates the MMSE, was administered to a household sample of 2978 individuals age 15 and older in Chile. DSM-III-R lifetime prevalence rates were estimated. The average MMSE score ranged from 16-29 depending on the level of educational attainment. Sociodemographic variables, including age marital status, urban-rural and income, impacted MMSE scores. When the MMSE scores were controlled for sociodemographic variables, those with any psychiatric disorder had significantly lower scores; however, specific diagnoses did not affect MMSE scores.     

Ethnic and educational differences in cognitive test performance on mini-mental state examination in Asians.

OBJECTIVE: The objective of this study is to examine ethnic differences in Mini-Mental State Examination (MMSE) test performance in discriminating between demented and nondemented elderly Asians. METHODS: A nationally representative population sample (N = 1,092) of community-living elderly, comprising Chinese, Malays, and Indians in Singapore, was interviewed using MMSE, Geriatric Mental State, and demographic and health questionnaires. RESULTS: There were significant ethnic differences in mean MMSE scores among Chinese (26.2), Indians (25.0), and Malays (23.6), but only in noneducated subjects. No ethnic differences in MMSE were observed in higher educated subjects. The sample proportion of subjects with dementia was 4.2% in Chinese, 9.4% in Malays, and 8.8% in Indians. Overall, MMSE discriminated well between subjects with and without dementia (cutoff: 23/24, area under the curve: 95%, sensitivity: 97.5%, specificity: 75.6%). MMSE test performance was much better in higher educated subjects (higher specificity: 85.2%). Lower specificities were shown in less educated subjects (57.3%), and in Malays (62.8%), and especially in less educated Malays (35.3%) and Indians (50.0%). Significant differences in MMSE scores in less educated subjects persisted after adjusting for differences in sociodemographic, health, and behavioral variables CONCLUSION: Ethnic nonequivalence in MMSE test performance should be taken into account in dementia screening in Asians in less educated subjects. Known correlates of cognitive functioning did not sufficiently explain these differences.     

Symptoms of depression and cognitive functioning in older American Indians

Depression and lower cognitive functioning are common conditions in older populations. While links between psychopathology and neuropsychological performance have been studied in the white majority population, little is known about such links in the American Indian population. American Indians aged 60 and older (n=140) completed structured interviews that included a depression screener and two cognitive screening measures, the Mini-Mental State Examination (MMSE) and the Mattis Dementia Rating Scale (MDRS). Participants had mean values of 26.7/30 on the MMSE and 125.8/144 on the MDRS. The depression screen was not associated with the MMSE or MDRS total scores. However, older American Indians who screened positive for depression scored lower than did those American Indians who screened negatively for depression (27.7 versus 29.8 respectively) on the MDRS conceptualization subscale after adjusting for sociodemographic and health variables. The combined effects of psychopathology and cognitive impairment are likely to adversely impact the health and welfare of American Indians and their families. More research is needed to provide a better understanding of the relationship between psychopathology and cognition that will help inform clinical treatment for psychopathology in older ethnic minorities.     

Use of the mini-mental state exam in middle-aged and older outpatients with schizophrenia: cognitive impairment and its associations.

OBJECTIVE: The authors examined cognitive impairment with a commonly used cognitive screening tool (the Mini-Mental State Exam [MMSE]) and its relationship to psychopathology, functional status, and other clinically relevant participant characteristics in 161 middle-aged and older outpatients with schizophrenia and 86 normal-comparison participants (NCs). METHODS: Participants completed the MMSE and standardized rating scales of psychopathology and motor symptoms. Other aspects of daily functioning were also evaluated. RESULTS: Patients had worse mean MMSE scores than NCs; 23% of the patients, but no NCs, had MMSE totals 相似文献   

Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

ABSTRACT Background: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status. Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed. Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain. Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.     

北京城乡55岁或以上居民简易智能状态检查测试结果的分布特征

目的研究简易智能状态检查（ＭＭＳＥ）测试结果的分布特征,为制定适合我国国情的筛查分界值的标准提供科学的依据。方法通过分层多级整群抽样,以北京市５５岁或以上５３６７名居民为样本。总结其简易智能状态检查（ＭＭＳＥ）测试结果的百分位数值和均值的年龄、性别和受教育程度的分布;比较我国不同的ＭＭＳＥ筛查分界值检测痴呆的效度。按城市和农村建立多元线性回归方程,分析影响测试结果的因素。结果５５～５９岁至８５岁或以上年龄组的居民,在文盲组、小学组、初中及以上组,中位ＭＭＳＥ成绩分别为２３～１８,２７～２４,２９～２７分。性别、年龄和受教育程度诸因素均对ＭＭＳＥ得分有显著影响（Ｐ＜０．０１）。ＭＭＳＥ的分界值文盲组≤１９分、小学组≤２２分、初中及以上组≤２６分检测痴呆的敏感度（城乡分别为９０．７％和９７．１％）高于既往常用的分界值（城乡分别为６６．７％和７８．６％）。结论ＭＭＳＥ得分是判断认知功能是否正常的非特异性指标,不能取代临床诊断。我们调整的分界值标准,有助于早期发现痴呆病人,减少漏诊。我国既往报道的痴呆患病率远低于西方国家的原因之一可能和筛查分界值较低有关。     

The clinical applications of Mini-Mental State Examination in geropsychiatric inpatients

OBJECTIVE: This study investigated the association between Mini-Mental State Examination (MMSE) scores and diagnosis, computerized tomographic scans or electroencephalogram findings in geropsychiatric inpatients (age > or = 65). METHOD: We analyzed the MMSE records of patients sixty-five and older who had been hospitalized in our psychiatric ward during a nine-year period. Case data were collected by review of chart records. RESULTS: In these patients, MMSE scores were significantly different among the seven diagnostic groups included. Demented patients had the lowest MMSE scores. Patients who had abnormal findings on computerized tomographic scans or electroencephalogram had lower MMSE than patients with normal findings. CONCLUSION: Our findings suggest that the MMSE is a useful screening instrument for organicity in the geropsychiatric inpatients. However, because of the lower average MMSE score in geropsychiatric inpatients, the optimal cut-offpoint of MMSE for dementia should be lower than those used in other populations.     

Profiles of cognitive subtest impairment in the Montreal Cognitive Assessment (MoCA) in a research cohort with normal Mini-Mental State Examination (MMSE) scores

The comparative ability of the Montreal Cognitive Assessment (MoCA) and MMSE to detect mild cognitive difficulties was investigated in 107 older adults. The sensitivity of the MoCA to detect cognitive impairment with a cutoff score of <26 was investigated, as compared to the MMSE across all scores, and at a cutoff of ≥27. Performance on MoCA subtests was compared at these MMSE cutoffs to determine profiles of early cognitive difficulties. The MoCA detected cognitive impairment not detected by the MMSE in a high proportion of participants, and this impairment was evident across various subtests. The MoCA appears to be a sensitive screening test for detection of early cognitive impairment.     

Impulsivity in euthymic patients with major depressive disorder: the relation to sociodemographic and clinical properties

The purpose of this study was to examine the trait impulsivity of patients with a major depressive disorder and to explore the possible connections between impulsivity and clinical and sociodemographic variables. The sociodemographic and clinical properties of 60 patients with major depression, who were euthymic according to Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11) and the impulsivity subscale of the Temperament and Character Inventory, and the results were compared with those of 50 age- and sex-matched healthy controls. We used general linear model analysis to evaluate the manner in which the variables contributed to BIS-11 scores. Some impulsivity scores were higher in those with a major depressive disorder than in comparison subjects. There were significant effects of education and sex in these differences. Elevated BIS-11 scores were associated with a history of psychotic mood episode and suicide attempts. These relationships persisted when age, sex, and education were taken into account. These results show that, after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with major depressive disorder than in comparison subjects and may be associated with sociodemographic and clinical properties.     

Changes in depressive symptoms and functional disability among community-dwelling depressive older adults

ABSTRACT Background: Previous studies have shown that the presence of depressive symptoms among older persons was evidently associated with subsequent physical and functional decline. However, few studies have directly examined the impact of changes in depressive symptoms or depressed mood on changes in functional ability. The present prospective study examined whether changes in the levels and remission of depressive symptoms were associated with changes in functional ability among community-living older persons who were treated for depressive symptoms in a primary care setting. Methods: Older persons aged 60 and above with depressive symptoms (N = 267) were followed up in a primary care treatment program over 12 months. Geriatric Depression Scale (GDS-15), and instrumental and basic activities of daily living (IADL and ADL) were measured at baseline and at 12-month follow-up. The associations of GDS change scores and conversion to non-depressed status with ADL and IADL change scores, controlling for baseline covariates including chronic medical comorbidity and Mini-Mental State Examination (MMSE), were examined in multiple regression analyses. Results: An improvement in GDS scores (baseline score minus 12-month score) was significantly associated with improvement (12-month score minus baseline score) in ADL (β = 0.355, p < 0.001) and IADL scores (β = 0.165, p = 0.018) after adjusting for baseline functional status, MMSE, chronic medical comorbidities, and other variables. In particular, conversion in GDS status to "non-depressive" state (GDS ≤4) was associated with an improvement in ADL change scores (β = 0.281, p = 0.019). Conclusion: In depressed older persons, an improvement in depressive symptoms was associated with improved functional ability.     

Body mass index and depressive symptoms in older adults: the moderating roles of race, sex, and socioeconomic status.

OBJECTIVE: Although the long-term health risks associated with obesity in older adults have been well documented, less is known about the psychological consequences. The current study examined the relationship between body mass index (BMI) and subsequent depressive symptoms. The authors anticipated that BMI would predict depressive symptoms, and that this relationship would be greater among women, individuals of higher socioeconomic status (SES), and white subjects. METHODS: A three-year longitudinal epidemiological design was employed. Participants were obtained from a biracial sample of community-dwelling older adults (N = 2,406) and were interviewed in their home by trained interviewers. A comprehensive survey assessed age, gender, race, SES (education and income), and health functioning variables. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. BMI was derived from self-reported weight and height. RESULTS: BMI was found to predict depressive symptoms. Contrary to predictions, the influence of BMI on depressive symptoms was greater for African Americans than whites and, in particular, African Americans with less education. There were no sex differences. CONCLUSION: Among older adults, BMI was associated with depressive symptoms although the effect size was small. Factors contributing to this relationship may differ from those observed in younger populations, for example, health functioning may play a larger role. Obesity appears to have the most adverse impact on those who are most likely to be overweight, lower SES African Americans.     

The clinical utility of the Hopkins Verbal Learning Test as a screening test for mild dementia

OBJECTIVE: The purpose of this study was to determine whether the Hopkins Verbal Learning Test (HVLT) could be used as a valid and reliable screening test for mild dementia in older people, and to compare its performance to that of the Mini-Mental State Examination (MMSE). METHOD: Using a cross-sectional design, we studied three groups of older subjects recruited from a district geriatric psychiatry service: (1) 26 patients with DSM-IV dementia and MMSE scores of 18 or better; (2) 15 patients with psychiatric diagnoses other than dementia; and (3) 15 normal controls. The relationship of each potential cutting point on the HVLT and the MMSE was examined against the independently ascertained DSM-IV diagnoses of dementia using a Receiver Operating Characteristic (ROC) analysis. RESULTS: The subjects consisted of 21 (37.5%) males and 35 (62.5%) females with a mean age of 74.7 (SD 6.1) years and a mean of 8.5 (SD 1.8) years of formal education. ROC analysis indicated that the optimal cutting point for detecting mild dementia in this group of subjects using the HVLT was 18/19 (sensitivity=0.96, specificity=0.80) and using the MMSE was 25/26 (sensitivity=0.88, specificity=0.93). CONCLUSIONS: The HVLT can be recommended as a valid and reliable screening test for mild dementia and as an adjunct in the clinical assessment of older people. The HVLT had better sensitivity than the MMSE in detecting patients with mild dementia, whereas the MMSE had better specificity.     

3MS normative data for elderly African Americans

The Modified Mini-Mental State Examination (3MS) is an expanded and modified version of the Mini-Mental Status Exam (MMSE). Although the MMSE has achieved widespread clinical use as a brief cognitive screen, the utility of the measure to ascertain cognitive impairment is constrained by a limited set of abilities sampled, a narrow range of possible scores, floor and ceiling effects, and by a paucity of normative data for use with older adults from ethnically diverse backgrounds. Research demonstrates that the reliability, validity, and sensitivity of the 3MS are superior to that of the MMSE in detecting cognitive impairment. To date there has been minimal research investigating the usefulness of the 3MS with African American older adults. The current study examined the influence of demographic characteristics on the 3MS in a community-dwelling sample of 238 African American older adults (60-84 years). Age, gender, and education accounted for moderate amounts of variance in 3MS performance. Based on these results, normative tables for 3MS scores, stratified by age and with score adjustments for education and gender, are provided.     

Latent Semantic Analysis: an improved method to measure cognitive performance in subjects of Non-English-Speaking-Background

The present study examined the validity of cognitive assessment in older adults when administered in a second language (English). A battery of tests that included the MMSE, CAMCOG and the Logical Memory Test of the Wechsler Memory Scale III, was administered to 121 older community volunteers of either an English Speaking Background (ESB) or a Non-English Speaking Background (NESB) living in the metropolitan area of Perth, Western Australia. The logical memory test was scored using Latent Semantic Analysis. It was hypothesized that this scoring method would be less affected by cultural and linguistic differences than standard scoring methods. The results suggest that LSA is a more robust measure of cognitive function than traditional scoring methods and may therefore improve the validity of cognitive assessment results on subjects of NESB.     

Performance on the Mini-Mental State Examination and Mattis Dementia Rating Scale among older American Indians

Optimal methods for assessing cognitive impairment among older American Indians have not been established. This study sought to examine the cultural relevance and performance of two common cognitive screening measures, the Mini-Mental State Examination (MMSE) and Mattis Dementia Rating Scale (MDRS), in one American Indian population. One hundred forty American Indians ages 60 to 89 were assessed; nearly 11% scored more than 2 standard deviation points below performance expectations on the MMSE, as did 27% to 81% on the MDRS. Complex relationships were found between gender, health conditions (with possible effects on cognitive functioning), and MMSE and MDRS scores. The authors discuss implications and future directions.     

Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder

OBJECTIVE: Data characterizing bipolar disorder in older people are scarce, particularly on functional status. We evaluated health-related quality of life and functioning (HRQoLF) among older outpatients with bipolar disorder as well as the relationship of HRQoLF to bipolar illness characteristics. METHOD: We compared community-dwelling middle-aged and older adults (age range, 45 to 85 years) with bipolar disorder (N=54; mean age=57.6 years), schizophrenia (N=55; mean age=58.5 years), or no psychiatric illnesses (N=38; mean age=64.7 years) on indicators of objective functioning (e.g., education, occupational attainment, medical comorbidity) and health status (e.g., Quality of Well-Being scale [QWB] and the Medical Outcomes Study-Short Form Health Survey [SF-36]). Within the group with bipolar disorder, we examined the relationship between HRQoLF and clinical variables (e.g., phase and duration of illness, psychotic symptoms, cognitive functioning). RESULTS: Patients with bipolar disorder were similar in educational and occupational attainment to the normal comparison group, but they obtained lower scores on the QWB and SF-36 (with large effect sizes). Compared with schizophrenia, bipolar disorder was associated with better educational and work histories but similar QWB and SF-36 scores and more medical comorbidity. Patients in remission from bipolar disorder had QWB scores that were worse than those of normal comparison subjects. Greater severity of psychotic and depressive symptoms and cognitive impairment were associated with lower HRQoLF. CONCLUSIONS: Bipolar disorder was associated with substantial disability in this sample of older adults, similar in severity to schizophrenia. Remission of bipolar disorder was associated with significant but incomplete improvement in functioning, whereas psychotic and depressive symptoms and cognitive impairment seemed to contribute to lower HRQoLF.     

The Montreal Cognitive Assessment (MoCA) is Superior to the Mini Mental State Examination (MMSE) in Detection of Korsakoff’s Syndrome

The Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) are brief screening instruments for cognitive disorders. Although these instruments have frequently been used in the detection of dementia, there is currently little knowledge on the validity to detect Korsakoff’s syndrome (KS) with both screening instruments. KS is a chronic neuropsychiatric disorder associated with profound declarative amnesia after thiamine deficiency. A representative sample of 30 patients with KS and 30 age-, education-, gender- and premorbid-IQ-matched controls was administered the MoCA and MMSE. The area under the receiver operating characteristic curve (AUC) was calculated in addition to the sensitivity, specificity, positive predictive value, and negative predictive value for various cut-off points on the MoCA and MMSE. Compared with the MMSE, the MoCA demonstrated consistently superior psychometric properties and discriminant validity—AUC: MoCA (1.00 SE .003) and MMSE (0.92 SE .033). When applying a cut-off value as suggested in the manuals of both instruments, the MMSE (< 24) misdiagnosed 46.7% of the patients, while the MoCA (< 26) diagnosed all patients correctly. As a screening instrument with the most optimal cut-offs, the MoCA (optimal cutoff point 22/23, 98.3% correctly diagnosed) was superior to the MMSE (optimal cutoff point 26/27, 83.3% correctly diagnosed). We conclude that both tests have adequate psychometric properties as a screening instrument for the detection of KS, but the MoCA is superior to the MMSE for this specific patient population.     

Admissions of elderly patients from English-speaking and non-English-speaking backgrounds to an inpatient psychogeriatric unit.

OBJECTIVE: The aim of this study was to compare differences between elderly patients from non-English-speaking backgrounds (NESB) and English-speaking backgrounds (ESB) admitted to an acute psychogeriatric unit. METHOD: Sociodemographic and clinical variables were collated from inpatient files for a 12-month period and analysed according to NESB and ESB status. The 1996 Australian Census data were used for comparison of catchment area representation of different ethnic groups. RESULTS: With a few exceptions, admission rates for elderly patients from NESB reflected the representation of that ethnic group in the catchment area population figures. No significant differences were found between the two groups for mean age, length of stay and previous admissions to the unit. Patients from NESB were less likely to be admitted voluntarily and less likely to be diagnosed with affective disorder. These differences were more marked for males, who were more likely to be diagnosed with dementia. CONCLUSIONS: These findings suggest that further investigation is required into the accessibility of psychiatric hospitalisation for elderly patients from NESB. Under-recognition of disorders such as depression and reluctance to accept necessary inpatient management are two possible factors that should concern mental health service providers for the ethnic elderly. A subsequent analysis will examine if differences also exist between elderly patients from NESB and ESB who receive community-based psychiatric treatment. Implications for mental health service provision for the elderly from NESB are discussed.